Municipality Successfully Defends PSEBA Claim

On October 3, 2014, a municipality represented by ZRFM’s Carlos Arévalo and faced with a Public Safety Employee Benefits Act (PSEBA) lawsuit, finally received word of whether or not it would be responsible to pay the plaintiff, the widow of a firefighter suffering an off-duty heart attack, for her health insurance benefits. Also at issue in the lawsuit were attorney’s fees if the plaintiff’s claims were successful. The Circuit Court issued a ruling in favor of the municipality, denying PSEBA benefits. The plaintiff in the case opted not to pursue an appeal of the court’s decision, resulting in the end of litigation against the municipality that dated back to late 2012.

Pursuant to PSEBA, a safety employee such as a firefighter, who suffers a catastrophic injury or is killed in the line of duty, is entitled to have the employer pay the entire health insurance plan premium for the employee, the employee’s spouse, and dependent children up to age 25. PSEBA became law in 1997. Its scope over the last decade has been expanded primarily through litigation reaching the Supreme Court and intermediate appellate courts but not through action by the Illinois General Assembly. The most significant Supreme Court decision involving PSEBA was issued in 2004 when it ruled that suffering a “catastrophic injury” was equivalent to an injury resulting in the employee being awarded a “line of duty disability” by a pension board. As a result of this ruling, employees who were no longer physically fit to serve as police officers or firefighters due to duty related injuries were able to demand that their municipality pay for their health insurance premiums. Assuming that their injuries occurred within the scope of their employment and certain other parameters were met, such claims were generally successful. While PSEBA is clearly appropriate in a scenario where the employee can no longer work as a result of his disability, local government advocates have sought amendments to PSEBA that would prevent the benefits in cases where the employee is capable of obtaining gainful employment. These efforts have been largely unsuccessful.

More recent litigation has focused on PSEBA’s requirements that the injury would have to occur as a result of the employee’s “response to what is reasonably believed to be an emergency.” In early 2012, the Supreme Court interpreted this phrase and explained that to be eligible, PSEBA requires an injury to be sustained in response to “what was reasonably believed to be an unforeseen circumstance involving imminent danger to a person or property requiring an urgent response.”

In this case, the plaintiff sought to expand PSEBA even further. Specifically, the plaintiff argued that PSEBA should be expanded to cover injuries to firefighters that were sustained over the course of years of active fire service. Essentially, the plaintiff sought to have the court interpret PSEBA to include cumulative occupational diseases that would potentially, but not necessarily, result in the firefighter’s death, even if he was not on duty at the time. The firefighter at issue passed away at home as a result of a heart attack. While acknowledging the tragic circumstances of the firefighter’s death, the municipality argued that the firefighter’s fatal heart attack occurred off-duty and that therefore he was not killed in the line of duty as such phrase is used in PSEBA. In addition, the municipality maintained that PSEBA was not intended to address occupational diseases.

In agreeing with the municipality’s arguments, the court stated that the phrase “killed in the line of duty” as used in the PSEBA was to be given its “plain, unambiguous meaning” and that considering the lack of indication to the contrary by either the appellate courts or the legislature, PSEBA was not intended to include “cumulative occupational disease deaths” in its definition of “killed in the line of duty.” Accordingly, the court determined that the firefighter was not “killed in the line of duty,” as he was neither on duty nor killed by a specific act of duty. As a result, the plaintiff was not entitled to PSEBA benefits.